Network Analysis of Depression, Anxiety, Posttraumatic Stress Symptoms, Insomnia, Pain, and Fatigue in Clinically Stable Older Patients With Psychiatric Disorders During the COVID-19 Outbreak

Abstract

Objectives The Coronavirus Disease 2019 (COVID-19) pandemic has profound negative effects on the mental health of clinically stable older patients with psychiatric disorders. This study examined the influential nodes of psychiatric problems and their associations in this population using network analysis. Methods Clinically stable older patients with psychiatric disorders were consecutively recruited from four major psychiatric hospitals in China from May 22 to July 15, 2020. Depressive and anxiety syndromes (depression and anxiety hereafter), insomnia, posttraumatic stress symptoms (PTSS), pain, and fatigue were measured using the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, Posttraumatic Stress Disorder Checklist - Civilian Version, and Numeric Rating Scales for pain and fatigue, respectively. Results A total of 1063 participants were included. The network analysis revealed that depression was the most influential node followed by anxiety as indicated by the centrality index of strength. In contrast, the edge connecting depression and anxiety was the strongest edge, followed by the edge connecting depression and insomnia, and the edge connecting depression and fatigue as indicated by edge-weights. The network structure was invariant by gender based on the network structure invariance test (M = .14, P = .20) and global strength invariance tests (S = .08, P = .30). Conclusions Attention should be paid to depression and its associations with anxiety, insomnia, and fatigue in the screening and treatment of mental health problems in clinically stable older psychiatric patients affected by the COVID-19 pandemic.

Psychological impact of COVID-19: A cross-lagged network analysis from the English Longitudinal Study of Aging COVID-19 database

“…Studies have reported that adults older than 50 years report greater physical health problems, especially those with a diagnosis of depression (79). People with these comorbidities may present somatic and physiological symptoms that reinforce a greater degree of fatigue, lack of energy, and insomnia (80).…”

The Impact of Event Scale – Revised: Examining its cutoff scores among Arab psychiatric patients and healthy adults within the context of COVID-19 as a collective traumatic event

“…The COVID-19 pandemic has been extensively described as a collective trauma, which has been associated with a global increase in PTSD symptoms in different population groups [3,7,[12][13][14][15]. Variations in PTSD symptom clusters have been revealed by different robust statistical methods [15,18,29,36], and they have been integrated in the most recent versions of the DSM [3,16].…”

“…In addition, terrorizing images of the outbreak and fake information communicated by mass/social media have accelerated fear levels regarding the effects of the pandemic on home finance and availability of food and essential supplies; they also heightened psychological distress and intensified traumatic emotions in the general public [2,10,11]. In this respect, many studies report higher occurrence of psychological trauma in COVID-19 survivors [3], healthcare workers [12], older adults (with psychiatric disorders) [13], adolescents and young adults [14,15], and even children [7].…”

The Impact of Event Scale-Revised: Examining Its Cutoff Scores among Arab Psychiatric Patients and Healthy Adults within the Context of COVID-19 as a Collective Traumatic Event

“…In addition, horrifying images of the pandemic and false/fake information frequently circulated in mass/social media have accelerated worries concerning the effects of COVID-19 on home finance and the availability of food and essential supplies; they also heightened psychological distress and to some extent intensified negative emotions/exaggerated fear responses to the pandemic in the general public [ 2 , 10 , 11 ]. In this respect, many studies report higher occurrences of psychological trauma in COVID-19 survivors [ 3 ], healthcare workers [ 12 ], older adults (with psychiatric disorders) [ 13 ], adolescents and young adults [ 14 , 15 ], and even children [ 7 ].…”